1. Differential diagnosis of head and neck swellings
Dr.Ali AL-Hiyali
BDS,MSc OMFS university of Glasgow(UK)
BDS

2. Tutorial outcomes
Understand the term and importance of differential diagnosis (DDx)
Know the aetiology of head and neck swellings
Know the investigation used in the management process

3. What Is DDx ?
the distinguishing of a disease or condition from others presenting with similar signs and symptoms
Emil Kraepelin father of DDx

5. Head and neck swellings
Numerous masses may develop in the head and neck, and these may also be termed swellings, growths, tumors, lumps, and bumps.
Although some swellings are cancerous , many are not.
However, it is important to investigate if any abnormal bump or swelling persists for more than two weeks.

6. what type of structures found in the head and neck region
Lymph nodes
Salivary glands
Fat tissue
Blood vessels
Thyroid and parathyroid glands
Thymus
Potential spaces (fascia spaces)

7. DDx of head swellings Inflammatory Trauma
Lymphadenopathy (inflammatory or metastatic )(most common)
Infections (viral or bacterial )
Trauma
Cysts (Dermoid , epidermoid , sebaceous and lipoma)
Bone diseases
Paget’s disease
Cherubism
Benign ( fibrous dysplasia , ossifying fibroma )
Malignant
Salivary glands disorders
Infections
Benign
Other benign or malignant lesions (Squamous cell carcinoma, lymphoma )

9. DDx of neck swellings

11. DDx of neck swellings based on the anatomical site:

13. Symptoms Associated with Head & Neck Lumps
Change in the voice including hoarseness that
persists for more than two weeks
Growth in the mouth
Swollen tongue
       Blood in the saliva or phlegm
  Swallowing problems

14. Radiographic investigations
Management process
History
Clinical examination
Radiographic investigations
Biopsy

15. History Lump or swelling for more than 2 weeks
Voice changes (hoarseness)
Growth in the mouth
Swollen tongue or limited movement
Blood in the saliva or phlegm
Dysphagia
Difficulties in breathing

16. Clinical examination
Inspection for any redness, ulceration, purple colour, size and site)
Palpation (fixed, movable ,hard ,fluctuant or pulsation, pain)

17. Summary of examination
Examination of some masses / swelling may allow a physician to determine their cause based on location, size, and consistency.
In other cases, however, additional tests may be required.
Changes in the skin – It is important to examine changes in the skin that could indicate basal cell carcinoma, squamous cell cancer, and malignant melanoma.
Persistent Ear Pain or ear pain while swallowing may be a symptom of infection or a growth in the throat.

20. Radiographic Investigation of the Head and Neck Masses
MRI – Magnetic Resonance Imaging can clearly highlight soft tissue pathologies better than the C.T. Scan.
It uses a magnetic field rather than x-rays (radiation).

21. Radiographic Investigation of the Head and Neck Masses
CT SCAN – Computed tomography is less accurate than M.R.I for the soft tissue examination
very useful to locate bony tumors and their dimensions and extensions.
C.T with contrast is used to enhance the visibility of abnormal tissue during examination.

22. Radiographic Investigation of the Head and Neck Masses
PET (Positron Emission Tomography) and SPECT (Single Photon Emission Tomography) are useful after diagnosis to help determine the grade of a tumor or to distinguish between cancerous and dead or scar tissue.
They involve injection with a radioactive tracer.

23. Biopsy F.N.A.C – Fine Needle Aspiration Biopsy is Safe Rapid
Inexpensive
Presurgical planning
Avoids open biopsy

24. Treatment modalities
Medical
Surgical
Radiotherapy